NURS 121L-B: Medication Administration & Safety Checks
Comprehensive Exam 2026 |WCU
1. When preparing medications for a patient, at which point does the nurse
perform the ‘second check’ of the three safety checks?
A. When reaching for the container or unit dose package in the medication drawer.
B. After the medication is prepared and before returning the multi-dose container to the drawer.
C. At the patient’s bedside immediately before administering the medication.
D. While documenting the administration in the Electronic Health Record (EHR).
Answer: B
Rationale: The second check occurs after the medication is retrieved and compared
against the MAR, usually during preparation or before returning the container.
2. A nurse is preparing to administer a high-alert medication. Which action is
most critical for ensuring patient safety?
A. Checking the medication label once before administration.
B. Verifying the patient’s room number against the medication order.
C. Administering the medication as quickly as possible to ensure therapeutic levels.
D. Asking a second licensed nurse to independently double-check the dose.
Answer: D
Rationale: High-alert medications (e.g., insulin, heparin) require an independent double-
check by another licensed nurse to prevent catastrophic errors.
,3. Which pharmacokinetic process is most significantly affected in a patient with
end-stage renal disease?
A. Excretion
B. Distribution
C. Metabolism
D. Absorption
Answer: A
Rationale: Excretion is primarily handled by the kidneys; renal impairment leads to drug
accumulation and potential toxicity due to reduced clearance.
4. A patient has an order for an enteric-coated medication but is having
difficulty swallowing. What is the nurse’s best action?
A. Crush the medication and mix it with applesauce.
B. Contact the prescriber to request an alternative form of the medication.
C. Dissolve the medication in warm water before administration.
D. Instruct the patient to chew the tablet thoroughly.
Answer: B
Rationale: Enteric-coated medications must not be crushed or chewed as it destroys the
coating intended to protect the stomach or delay absorption.
5. When administering an intramuscular (IM) injection using the Z-track
method, what is the primary purpose of this technique?
A. To reduce the pain associated with the needle insertion.
B. To allow for a faster rate of absorption.
C. To ensure the medication enters the vein directly.
D. To prevent the medication from leaking back into the subcutaneous tissue.
Answer: D
Rationale: The Z-track method creates a zigzag path that seals the medication within the
muscle tissue and prevents irritation of subcutaneous layers.
, 6. What is the first action a nurse should take if a medication error is
discovered?
A. Assess the patient’s condition and vital signs.
B. Notify the nurse manager and the pharmacy.
C. Complete an incident report immediately.
D. Call the healthcare provider to report the error.
Answer: A
Rationale: The nurse’s first priority is always patient safety; therefore, assessing the
patient for adverse effects is the immediate first step.
7. Which site is preferred for intramuscular injections in infants under 12
months of age?
A. Deltoid
B. Vastus lateralis
C. Dorsogluteal
D. Ventrogluteal
Answer: B
Rationale: The vastus lateralis is the preferred site for infants because it is a well-
developed muscle and lacks major nerves and blood vessels.
8. A nurse is administering a sublingual medication. Which instruction should be
provided to the patient?
A. Swallow the pill with a full glass of water.
B. Chew the pill before swallowing for faster absorption.
C. Place the tablet between the cheek and the gum.
D. Place the tablet under the tongue and allow it to dissolve completely.
Answer: D
Rationale: Sublingual medications are placed under the tongue to be absorbed through the
highly vascular mucous membranes, bypassing the digestive system.
Comprehensive Exam 2026 |WCU
1. When preparing medications for a patient, at which point does the nurse
perform the ‘second check’ of the three safety checks?
A. When reaching for the container or unit dose package in the medication drawer.
B. After the medication is prepared and before returning the multi-dose container to the drawer.
C. At the patient’s bedside immediately before administering the medication.
D. While documenting the administration in the Electronic Health Record (EHR).
Answer: B
Rationale: The second check occurs after the medication is retrieved and compared
against the MAR, usually during preparation or before returning the container.
2. A nurse is preparing to administer a high-alert medication. Which action is
most critical for ensuring patient safety?
A. Checking the medication label once before administration.
B. Verifying the patient’s room number against the medication order.
C. Administering the medication as quickly as possible to ensure therapeutic levels.
D. Asking a second licensed nurse to independently double-check the dose.
Answer: D
Rationale: High-alert medications (e.g., insulin, heparin) require an independent double-
check by another licensed nurse to prevent catastrophic errors.
,3. Which pharmacokinetic process is most significantly affected in a patient with
end-stage renal disease?
A. Excretion
B. Distribution
C. Metabolism
D. Absorption
Answer: A
Rationale: Excretion is primarily handled by the kidneys; renal impairment leads to drug
accumulation and potential toxicity due to reduced clearance.
4. A patient has an order for an enteric-coated medication but is having
difficulty swallowing. What is the nurse’s best action?
A. Crush the medication and mix it with applesauce.
B. Contact the prescriber to request an alternative form of the medication.
C. Dissolve the medication in warm water before administration.
D. Instruct the patient to chew the tablet thoroughly.
Answer: B
Rationale: Enteric-coated medications must not be crushed or chewed as it destroys the
coating intended to protect the stomach or delay absorption.
5. When administering an intramuscular (IM) injection using the Z-track
method, what is the primary purpose of this technique?
A. To reduce the pain associated with the needle insertion.
B. To allow for a faster rate of absorption.
C. To ensure the medication enters the vein directly.
D. To prevent the medication from leaking back into the subcutaneous tissue.
Answer: D
Rationale: The Z-track method creates a zigzag path that seals the medication within the
muscle tissue and prevents irritation of subcutaneous layers.
, 6. What is the first action a nurse should take if a medication error is
discovered?
A. Assess the patient’s condition and vital signs.
B. Notify the nurse manager and the pharmacy.
C. Complete an incident report immediately.
D. Call the healthcare provider to report the error.
Answer: A
Rationale: The nurse’s first priority is always patient safety; therefore, assessing the
patient for adverse effects is the immediate first step.
7. Which site is preferred for intramuscular injections in infants under 12
months of age?
A. Deltoid
B. Vastus lateralis
C. Dorsogluteal
D. Ventrogluteal
Answer: B
Rationale: The vastus lateralis is the preferred site for infants because it is a well-
developed muscle and lacks major nerves and blood vessels.
8. A nurse is administering a sublingual medication. Which instruction should be
provided to the patient?
A. Swallow the pill with a full glass of water.
B. Chew the pill before swallowing for faster absorption.
C. Place the tablet between the cheek and the gum.
D. Place the tablet under the tongue and allow it to dissolve completely.
Answer: D
Rationale: Sublingual medications are placed under the tongue to be absorbed through the
highly vascular mucous membranes, bypassing the digestive system.
